System for providing medical information

ABSTRACT

A managed care expert system provides a graphical, interactive computer system which accepts user input relating to contract variables for a plurality of alternative contract scenarios, consults a database of national and locality-specific utilization data, performs a utilization and revenue analysis for both commercial and Medicare-age beneficiaries, and provides a synthetic fee schedule for comparing the likely revenue under capitation for a plurality of services to revenue for those services under a current reimbursement scenario. The system of the invention in its preferred embodiment enables a physician or other health care professional to use a broad array of assumptions to forecast utilization of medical procedures and estimated revenue per procedure under multiple capitation scenarios.

[0001] This application includes a microfiche appendix which has a totalof four microfiche and a total of 310 frames.

BACKGROUND OF THE INVENTION

[0002] 1. Field of the Invention

[0003] The invention relates in general to computer-based tools foraiding in business and financial decision-making, and in particular to anovel system for aiding a physician or other interested party in makingdecisions relating to contracts between health care payers and physiciancontractors or other health care providers.

[0004] 2. Background and Related Art

[0005] Capitated health care is rapidly gaining market acceptance inmany geographical areas. This environment raises many decisionalchallenges for the physician and administrators in the medical carefield. In particular, physicians and medical practice administratorsentering into capitated contracts have had difficulty in balancing theoften-conflicting goals of maintaining standards of quality in healthcare delivery and maintaining adequate practice revenue. One of theprincipal difficulties encountered in this regard has been the lack ofan accurate means for comparing revenues generated under an at-riskcontract with those generated under a traditional fee-for-servicearrangement. Specifically, difficulty has arisen in understanding theinteractions between an amount paid under a capitated contract, theutilization of services under the contract, and the resulting revenueearned in delivering those services.

SUMMARY OF THE INVENTION

[0006] It is therefore an object of the invention to provide acomputer-based system for comparing revenues and costs generated underan at-risk contract with those generated under a traditionalfee-for-service arrangement.

[0007] It is a further object of the invention to provide acomputer-based system for demonstrating to a user the interactionsbetween an amount paid under a capitated contract, the utilization ofservices under the contract, and the resulting revenue earned indelivering those services.

[0008] In a preferred embodiment, the invention provides a graphical,interactive computer system which accepts user input relating tocontract variables for a plurality of alternative contract scenarios,consults a database of national and locality-specific utilization data,performs a utilization and revenue analysis for both commercial andMedicare-age beneficiaries, and provides a synthetic fee schedule forcomparing the likely revenue and costs under capitation for a pluralityof services to revenue for those services under a current reimbursementscenario. The system of the invention in its preferred embodimentenables a physician to use a broad array of assumptions to forecastutilization of medical procedures and estimated revenue per procedureunder multiple capitation scenarios.

BRIEF DESCRIPTION OF THE DRAWINGS

[0009] The foregoing and other objects, features, and advantages of theinvention will be apparent from the following more particulardescription of preferred embodiments as illustrated in the accompanyingdrawings in which reference characters refer to the same partsthroughout the various views. The drawings are not necessarily to scale,emphasis instead being placed upon illustrating principles of theinvention.

[0010]FIG. 1 is a table illustrating the utilization of selectedprocedures under alternative scenarios.

[0011]FIG. 2 is a table illustrating expected Relative Value Units(RVUs) per beneficiary based on the table of FIG. 1.

[0012]FIG. 3 is a table illustrating expected revenue per procedurebased on the data in the table of FIG. 2.

[0013]FIG. 4 illustrates a schematic block diagram of a typical computerused to implement the invention.

[0014]FIG. 5 is a view of a graphical “Main” screen created by themachine of the invention.

[0015]FIG. 6 is a view of a graphical “Population Covered” screencreated by the machine of the invention.

[0016]FIG. 7 is a view of a graphical “Procedures Provided” screencreated by the machine of the invention.

[0017]FIG. 8 is a view of a graphical “Summary” screen created by themachine of the invention.

[0018]FIG. 9 is a view of a graphical “Utilization of Procedures” screencreated by the machine of the invention.

[0019]FIG. 10 is a view of a graphical “Utilization of Procedures—CPTCodes” screen created by the machine of the invention.

[0020]FIG. 11 is a view of a graphical “Expected RVU Per Beneficiary”screen created by the machine of the invention.

[0021]FIG. 12 is a view of a graphical “Expected RVU Per Beneficiary—CPTCodes” screen created by the machine of the invention.

[0022]FIG. 13 is a view of a graphical “Revenue” screen created by themachine of the invention.

[0023]FIG. 14 is a view of a graphical “Revenue—CPT Codes” screencreated by the machine of the invention.

DETAILED DESCRIPTION OF THE DRAWINGS

[0024]FIGS. 1 through 3 set forth a model illustrating the underlyingtheory which is put into practice by the machine of the invention. Themodel is based on all medical/surgical services likely to be provided toa Medicare beneficiary in the field of ophthalmology. It will beunderstood by those skilled in the art, however, that the analysis shownin the figures, and the machine of the invention, can be applied to anymedical specialty or all medical services. The basic premise is that adefined “basket” of services is likely to be provided to a group ofpatients over the course of a year. For instance, if 1000 beneficiariesmake 584 office visits under current utilization, the likelihood of anyone person making an office visit is 0.584.

[0025]FIG. 1 depicts the utilization of commonly performed proceduresunder Medicare indemnity patterns, compared with what might be observedif utilization were decreased by a uniform amount. The “Current”utilization column reflects the probability of a Medicare beneficiaryundergoing a particular procedure in 1991, based on national averages,while the remaining three columns represent scenarios whereinutilization of all procedures is 10%, 20% or 40% lower as compared tocurrent utilization. In reality, utilization of some services might bedeliberately increased. For instance, one might deliberately increaseutilization of eye examination and photocoagulation of patients withdiabetes with the expectation that fewer endolaser vitrectomies will beneeded.

[0026]FIG. 2 illustrates the expected Relative Value Units (RVUs) perbeneficiary (for a Covered Life Years or “CLY”) for the procedures shownin FIG. 1. Expected procedure-specific and total RVUs can be derived bymultiplying the utilization for each procedure (from FIG. 1) by the RVUvalue for that procedure under each utilization scenario. By convertingprocedures to RVU values and multiplying those values by the likelihoodthat a beneficiary will undergo a procedure in a particular year, it ispossible to estimate the amount of professional service likely to beprovided. Of course, these values hold only for large groups of people,and an individual may use more or less care.

[0027] As shown in FIG. 3, using the above inputs one can project therevenue per service, based on the per-member-per-month (PMPM) capitationamount. The capitation rate chosen ($6.50) is an approximate contractprice that has been reported for Medicare at-risk contracts in maturemanaged-care markets. Capitation rates considerably higher and lowerthan this will have obvious effects on total revenue and revenue perRVU. In contrast to a fee-for-service arrangement, in which the feerepresents that actual amount paid for a given service, independent ofutilization, this projected revenue represents the portion of the totalcapitation revenue that might be appropriately allocated to a givenservice at a particular level of utilization. With appropriatecost-accounting techniques, the estimated revenue per service can becompared with the actual cost of providing that service to determineprofit or deficit. The revenue per service (FIG. 3) is calculated asfollows: The total capitation amount (PMPMX12) is divided by total RVUper beneficiary (FIG. 2) to yield an expected revenue per RVU. Theexpected revenue per RVU is multiplied by the RVU value for eachprocedure.

[0028] The expected revenue per procedure does not include any copaymentor coinsurance, which may constitute a meaningful portion of revenue,particularly in an office visit. Although there are known imperfectionsin the RVU scale, the effect of those imperfections would be tooverestimate the revenue associated with some procedures and tounderestimate the revenue associated with others. While this might leadto erroneous calculation of profit or loss associated with theperformance of any individual procedure, it would have no effect onoverall reimbursement, since, by definition, that is fixed. Others whoapply this method may wish to adjust the RVU scale based on their owninformation, and such adjustments are discussed below in the descriptionof the machine according to the invention.

[0029] As shown in the model, revenue per procedure under capitated careis likely to be lower than current fee schedules if utilization ismaintained at current levels. There are some offsetting factors, such assubstantial reductions in billing and collection, more stable cash flow,and minimal bad debt. Equally apparent is that lower utilization rapidlytranslates into higher projected revenues per service. The problem isnot whether one can decrease utilization to the point where capitatedcare becomes financially attractive, but rather what mechanisms ofmonitoring process and outcomes of care must be in place to inform thephysician and safeguard the patient.

[0030] Turning now to a discussion of the preferred embodiment of theinvention, the invention includes a machine comprising a computersystem, operating pursuant to software, that produces a series ofscreens for permitting a user to create, select, and display informationrelating to managed care decision-making. As shown in FIG. 4, amicroprocessor 21 receives input information 27 from I/O 25, which maycomprise a keyboard, a mouse, a data storage device, a display, andother known input/output devices. Microprocessor 21 also causes outputinformation 29, such as a graphical or textual display, to flowtherefrom. Timing and control signals 37 are transferred between I/O 25and a memory 23. Instruction and data codes 33 flow between memory 23and microprocessor 21; data codes 35 flow between I/O 25 and memory 23,as well as between I/O 25 and microprocessor 21; address codes 31 frommicroprocessor 21 flow to memory 23 and I/O 25.

[0031] As set forth above, the invention produces a series of graphicalinteractive screens which permit a user to create information relatingto managed care decision-making. FIG. 4 issustrates a Main screenaccordng to a preferred embodiment of the invention. The Main screenconsists of boxes into with the user enters basic capitation assumptionsin order to project utilization and revenue implications for a givencapitation scenario. The user may specify three hypothetical scenarios,with different utilization and capitation rates for each, or may chooseto keep one set of variables, such as utilization rate, constant whilevarying the others. Data are entered using the up and down arrows(either on a mouse or a keypad) in order to minimize data errors, suchas misplaced decimal points, that are common when numbers are typed inby hand.

[0032] The “Utilization” rows on the Main screen allow a user toestimate the utilization under various capitation scenarios as itcompares with indemnity insurance. Thus, a value of 100% means that theuser is assuming utilization under capitation will be the same as underindemnity, while a value of 50% means that utilization under capitationis assumed to be half that of comparable beneficiaries under indemnityinsurance. Utilization is specified for all office diagnostic servicesand for surgical service as separate entries.

[0033] While it is impossible to predict what utilization ofophthalmologic procedures is likely to be under any particularcapitation plan, preliminary data have shown utilization experienceunder capitation that ranges from identical with indemnity to 40% belowindemnity (Javitt J. C. Early glimpses of capitated eye care. ArchOphthalmol 112:887, 1994). It would be unreasonable to assume thatutilization will automatically be lower than that under indemnity unlessmechanisms, such as gatekeeper accountability, are in place. Thepossibility also exists that reduction in copayment that is oftenexperienced when moving from indemnity to managed care plans may beassociated with an increase in office visit utilization.

[0034] The “Capitation Rate” rows of the Main screen permit a user toenter the capitation rates for the machine of the invention to use inits calculations. Rates are preferably on a per-member-per-month basis,but it will be appreciated by those skilled in the art that other typesof capitation rates, such as per-member-per-quarter, etc., could be usedwithout departing from the spirit and scope of the invention.

[0035] The “Co-Pay” rows permit a user to enter copayments for themachine of the invention to use in its calculations. If a copayment isentered for office services, the copayment is generally applied once pervisit. Thus, if two services are combined, such as a comprehensive eyeexamination and a visual field examination, the revenue per service forthe second (and any additional) service will be overstated by the amountof the copayment.

[0036] A button bar appears along the tope of the Main screen. Thebuttons permit a user to access any of a series of sub-screens or dialogboxes for inputing and outputting information. The functions of thesebuttons and associated subscreens or dialog boxes will now be discussed.

[0037] A “Population” button accesses a “Population Covered” dialog boxwhich is used to define the populations that are to be part of theanalyses performed by the device of the invention. The PopulationCovered dialog box is shown in FIG. 6. A series of age ranges are listedin the dialog box, and a user enters, for each age range, the number ofpatients which are to be covered under a certain contract or potentialcontract scenario. Data entered is saved or discarded by clicking theappropriate button along the top of the Population Covered dialog box.An “Exit” button is can be actuated to return the user to the Mainscreen (FIG. 1).

[0038] A “Procedures” button on the Main screen (FIG. 5) is used toaccess a “Procedures Provided” dialog box, illustrated in FIG. 7. TheProcedures Provided dialog box is used to select the ophthalmologicprocedures that are to be part of the analyses performed by the deviceof the invention. A user can view the CPT code for a proceduredouble-clicking on the procedure.

[0039] By selecting certain procedures for inclusion, and observing theresulting effect on the outcome of the analyses (discussed in moredetail below), a user can project the effect of being at-risk for alleyecare procedures versus being at-risk for sub-specialty proceduresonly. Procedures for which a health-care provider will not beresponsible under a particular contract may be left out of the analysisby de-selecting the check boxes in the right-hand column of theProcedures Provided dialog box. If the analysis is to include certainprocedures which are to be contracted out to other providers, thoseprocedures should remain selected for inclusion; the Revenue dialog box,discussed in detail below, will provide insight into the amount that maybe paid to other providers in a revenue-neutral manner.

[0040] There may also be situations in which providers are responsibleonly for subspecialty care, such as vitreo-retinal surgery. The machineof the invention may provide insight in this situation as well. However,the following caution applies. Currently, it is possible to estimate thenumber of surgical procedures to be performed in subspecialty areas butnot to separate office visits by the same categories. Therefore,selecting only subspecialty procedure types and inputting a subspecialtycapitation rate will estimate a revenue per procedure that includes alloffice visits, including visits for those persons who do not undergo asurgical procedure. It can be argued that all office visits with a givendiagnosis (such as retinal detachment) be attributed to the associatedsurgical procedure.

[0041] A “Summary” button on the Main screen (FIG. 5) is used to accessa “Summary” dialog box, which is illustrated in FIG. 8. The Summarydialog box displays a database of the number of procedures in aggregatedcategories for individuals under 65 and over 65. The Procedures dialogbox provides a tabular display of data, including a “Category” columnlisting procedures, a “Number of Procedures column for patients under65, and a “Number of Procedures” column for patients over 65.

[0042] A “Utilization” button on the Main screen (FIG. 5) accesses aUtilization-of-Procedures dialog box, which is illustrated in FIG. 9.The Utilization-of-Procedures dialog box permits a user to project theutilization of ophthalmologic procedures by beneficiary, under theutilization scenarios chosen on the Main screen. The default utilizationrates are derived from a national or locality-specific database of ratesobserved for a particular year. Utilization is expressed as a simplerate. For instance, a rate of 0.050 means that 5 persons per 100 or 50persons per thousand might undergo that procedure. Rates are based onthe experience of beneficiaries from a particular locality who werecovered by indemnity insurance in a particular year.

[0043] To view the utilization of procedures data by CPT code, a usercan double-click on a particular procedure. Doing so accesses a“Utilization of Procedures—CPT Codes” dialog box, which is illustratedin FIG. 10.

[0044] An “RVU” button on the Main screen (FIG. 5) is used to access an“Expected RVU Per Beneficiary” dialog box, which is illustrated in FIG.11. This dialog box is used to project the Relative Value Units (RVUs)of service associated with the categories of ophthalmologic servicelikely to provided under a particular contract or other scenario. RVU'sof service are preferably obtained by multiplying the utilization rateof each procedure by its RVU value, as reflected in a Medicare FeeSchedule. A user can select which of the four scenarios (i.e., Current,Scenario 1, Scenario 2, or Scenario 3) to display by using a mouse toclick one of the four buttons along the top of the screen.

[0045] While the use of relative value units to adjust payment ratesacross specialties is problematic because of difficulty of developingappropriate anchor procedures for comparison, the use of RVUs to compareone ophthalmologic procedure to another is less problematic, since thescale is based on answers provided by over 500 ophthalmologists.

[0046] To view the expected RVU data by CPT code, a user candouble-click on a particular procedure. Doing so accesses an “ExpecteddRVU Per Beneficiary—CPT Code” dialog box, which is illustrated in FIG.12.

[0047] A “Revenue” button on the Main screen (FIG. 5) accesses a“Revenue” dialog box, which is illustrated in FIG. 13. The Revenuedialog box projects the revenue associated with each procedure under thescenario of Capitation Rate/Copayment/Utilization chosen by the user.The Revenue dialog box comprises a clumnar display of data, including a“Category” column listing procedures, a “Revenue Per Service” forpatients under 65, and a “Revenue Per Service” column for patients over65. While the revenue analysis illustrated in FIG. 13 has the appearanceof a fee schedule, it is important to recognize the key difference,namely that predicted revenue will be underestimated if utilization ishigher than expected and vice versa.

[0048] The invention according to the preferred embodiment predictsRevenue Per Service, as displayed in the Revenue dialog box, accordingto the following steps:

[0049] First, determine the total RVUs per procedure and per personlikely to be provided under the chosen utilization scenario.

[0050] Second, calculate the Revenue (“R”) per RVU as follows:

R per RVU= (Capitation Rate×12)/Total RVUs per person

[0051] Third, calculate the Revenue Per Service (“RPS”) as follows:

RPS= (RVUs for service×Revenue per RVU)+Copay

[0052] The invention according to the preferred embodiment permits theuser to choose to display revenue data for a particular scenario byselecting any of the “Current Utilization,” “Scenario 1,” “Scenario 2,”or “Scenario 3” buttons along the top of the Revenue dialog box. A usermay also view revenue data by CPT Code by double-clicking a particularprocedure in the Category column. Doing so accesses a “Revenue—CPTCodes” dialog box, which is illustrated in FIG. 14.

[0053] A “Calculator” button on the Main screen (FIG. 5) accesses a“Capitation Calculator” dialog box, which is illustrated in FIG. 15.This dialog box permits use of the invention to perform ad hoccapitation calculations. A user selects Utilization and Co-Pay values bymanipulating the various spin buttons in the top block of the CapitationCalculator dialog box. The user can then select an appropriate radiobutton for his preferred calculation method, i.e., Dollars Per RVU, FeeSchedule (Aggregate), or Fee Schedule (CPT Code). Selecting the“Calculate” button causes the invention to display a resultingcapitation rate. The Capitation Calculator dialog box also preferablycomprises three editor buttons: a “Utilization Editor” button, an “RVUEditor” button, and a “Fee Schedule Editor” button. The functions foreach of the buttons are discussed below.

[0054] Selecting the “RVU Editor” button from the Capitation Calculatordialog box (FIG. 15) accesses an “RVU Editor” dialog box, which isillustrated in FIG. 16. The RVU Editor dialog box can also be accessedvia an “Advanced” menu on the Main screen (FIG. 5). The RVU Editorfunction of the invention permits a user to enter and selectuser-defined RVU values. The RVU Editor dialog box comprises a tabulardisplay of RVU data, including a Category column listing medicalprocedures, a “Default RVU” column listing widely-accepted default RVUvalues, and a “User Defined RVU” column in which a user can insertcustomized RVU values. A “Use Default” button causes the device of theinvention to use the default database of RVU values for purposes ofperforming calculations, while a “Use Custom” button causes the deviceto use a database which includes the User-Defined RVU values.

[0055] The “Utilization Editor” button in the Capitation Calculatordialog box (FIG. 15) accesses a “Utilization Editor” dialog box, whichis illustrated in FIG. 17. The Utilization Editor dialog box can also beaccessed via the “Advanced” menu in the Main screen (FIG. 1). Thedefault utilization rates used by the invention to perform calculationsare based on a database of national or locality-specific values observedfor a particular year. The Utilization Editor dialog box permits a userto enter user-defined utilization values to replace the default data. A“Use Default” button causes the invention to use the default databasefor calculations, while a “Use Custom” button causes the invention touse the customized utilization values defined by the user.

[0056] The “Fee Schedule Editor” button in the Capitation Calculatordialog box (FIG. 15) accesses an “Aggregate Editor—Medicare FeeSchedule” dialog box, which is illustrated in FIG. 18. The AggregateEditor—Medicare Fee Schedule dialog box can also be accessed via the“Advanced” menu in the Main screen (FIG. 1). The default fee data usedby the invention to perform calculations are based on a database whichreflects the Medicare Fee Schedule for aggregated procedures. Thisdialog box permits a user to enter user-defined fees for aggregatedprocedures. A “Use Medicare” button causes the invention to use thedefault Medicare Fee Schedule database for calculations, while a “UseCustom” button causes the invention to use the customized fee datadefined by the user. To view the fee data by CPT code, a user candouble-click on a particular procedure. Doing so accesses a “CPTEditor—Medicare Fee Schedule” dialog box, which is illustrated in FIG.19. This dialog box can also be accessed via the “Advanced” menu in theMain screen (FIG. 5).

[0057] The above-described “Advanced” menu further permits access to a“Locality Covered” dialog box, which is illustrated in FIG. 20. Thisdialog box permits a user to cause the machine of the invention to usealternate databases for its calculations so that the calculations usedata drawn from a population which closely matches that of coveredindividuals for a particular contract scenario. A user may select anational database or one of a plurality of locality-specific databases.The localities available preferably are based on health market areas,using the Bureau of Economic Analysis Economic Areas, which correspondto standard Metropolitan Statistical Areas combined with theirsurrounding suburban and rural counties.

[0058] The above-described “Advanced” menu further permits access to a“User ID” dialog box, which permits a user to enter a name andidentification number so as to permit use of the program by multiple,independent users. That is, a particular user's data is associated withhis User Id information and can be recalled at a later time.

[0059] While the invention has been particularly shown and describedwith reference to a preferred embodiment thereof, it will be understoodby those skilled in the art that various changes in form and details maybe made therein without departing from the spirit and scope of theinvention.

The embodiments of the invention in which an exclusive property orprivilege is claimed are defined as follows:
 1. A device for aiding inmanaged health care decision-making, comprising: means for selecting aplurality of medical procedures for analysis; means for storing a firstdatabase of health care utilization data indicating levels ofutilization for said plurality of procedures under a first scenario;means for receiving user input of at least one variable affecting anamount of revenue derived from providing health care under a secondscenario; means for creating, based at least in part upon said variableaffecting revenue and data in said said first database, a seconddatabase of health care utilization data indicating levels ofutilization for said plurality of procedures under said second scenario;means for projecting a first revenue amount relating to said firstscenario, said first revenue amount being derived at least in part fromsaid the data in said first database; means for projecting a secondrevenue amount relating to said second scenario, said second revenueamount being derived at least in part from said the data in said seconddatabase; and, means for displaying said first and second revenueamounts.
 2. The device according to claim 1, wherein said at least onevariable affecting revenue derived from providing health care comprisesan indication of utilization under said second scenario.
 3. The deviceaccording to claim 2, wherein at said indication of utilization undersaid second scenario comprises a percentage of a total utilization withrespect to a corresponding total utilization under said first scenario.4. The device according to claim 1, wherein said at least one variableaffecting revenue derived from providing health care comprises acapitation rate reflecting a level of compensation under said secondscenario.
 5. The device according to claim 1, wherein said at least onevariable affecting revenue derived from providing health care comprisesan amount of co-payment under said second scenario.
 6. The deviceaccording to claim 1, wherein said first database of health careutilization data comprises data for a specific geographic region, andwherein said first database is selected from a larger databasecomprising utilization data for a plurality of geographic regions. 7.The device according to claim 1, wherein said first scenario comprises ahealth care indemnity insurance scenario and said second scenariocomprises a managed care plan scenario.
 8. The device according to claim1, wherein said first scenario comprises a first managed care planscenario and said second scenario comprises a second managed care planscenario.
 9. A device for aiding in managed care decision-making,comprising: means for selecting a plurality of medical procedures foranalysis; means for storing a database of health care utilization dataindicating levels of utilization for a plurality of procedures; meansfor receiving user input of at least one desired revenue amount forinsuring provision of said plurality of procedures to a population;means for calculating, based at least upon said data in said databaseand said at least one desired revenue amount, a capitation ratereflecting a level of compensation statistically required to achievesaid desired revenue amount; and, means for displaying said capitationrate.
 10. A device for aiding in managed health care decision-making,comprising: means for selecting a plurality of medical procedures foranalysis; means for storing a first database of health care utilizationdata indicating levels of utilization for said plurality of proceduresunder a first scenario; means for receiving user input of at least onevariable affecting revenue derived from providing health care under asecond scenario; means for creating, based at least in part upon saidvariable affecting revenue and data in said said first database, asecond database of health care utilization data indicating levels ofutilization for said plurality of procedures under said second scenario;means for displaying said second database of health care utilizationdata indicating levels of utilization for said plurality of proceduresunder said second scenario.
 11. A device for aiding in managed healthcare decision-making, comprising: means for selecting a plurality ofmedical procedures for analysis; means for storing a first database ofhealth care utilization data indicating levels of utilization for saidplurality of procedures under a first scenario; means for receiving userinput of at least one variable affecting revenue derived, from providinghealth care under a second scenario; means for creating, based at leastin part upon said variable affecting revenue and data in said said firstdatabase, a second database of health care utilization data indicatinglevels of utilization for said plurality of procedures under said secondscenario; means for storing a third database of data representingrelative value units for each of said plurality of medical procedures;means for creating a fourth database of relative-value-units-per-servicebased at least in part upon said data in said second database and saiddata in said third database.